Timely Referral to Hospice Care for Oncology Patients: A Retrospective Review

Am J Hosp Palliat Care. 2019 Jun;36(6):466-471. doi: 10.1177/1049909118820494. Epub 2018 Dec 26.


Hospice care is medical care provided to terminally ill patients with a life expectancy of 6 months or less. Hospice services include symptom control, pain management, palliative care, and other supportive services such as providing for home equipment or oxygen; however, it does not provide for life-prolonging therapies such as chemotherapy. Although oncologic benchmarks suggest patients should be enrolled in hospice 3 months prior to death, studies show that most hospice referrals are being made too late. These shorter stays in hospice result in increased cost of care especially at the end of life with most patients dying on aggressive treatments in the hospital. Thus, identifying barriers to hospice placement is critical in improving the referral process and enhancing the quality of end-of-life care. This retrospective study collected data on 418 oncologic patients who passed in 2015 and categorized patients based on hospice status at the time of death. Our study found that the demographics between hospice and nonhospice patients were not significantly different. Hospice patients spent a median of 10 days in hospice and 71% (n = 161) of patients were in hospice 30 days or less. Additionally, 56% of patients were in hospice 10 days or less. Increased education for patients and health-care providers along with better utilization of palliative care services and incorporating a nurse navigator to help with transitioning patients to hospice would improve earlier referral to hospice care and enhance patients' quality of life.

Keywords: education; end-of-life care; hospice; hospice referral; length of stay; oncology; palliative care.

MeSH terms

  • Aged
  • Female
  • Hospice Care / organization & administration
  • Hospice Care / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms*
  • Palliative Care / organization & administration
  • Quality Improvement / organization & administration
  • Referral and Consultation / organization & administration
  • Referral and Consultation / statistics & numerical data*
  • Retrospective Moral Judgment
  • Retrospective Studies
  • Socioeconomic Factors